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High-risk insurance pools short on enrollees

The experience of the ACA high-risk pools hold some lessons for 2014. | Reuters

Yet despite that, just about 45,000 people have signed up — well short of the 375,000 the Medicare actuary had predicted for the end of 2010. So why haven’t there been more?

Cost, for starters. Premiums for really needy people still aren’t cheap and enrollment suffered because of it. That prompted the federal government to slash premiums in the 24 state high-risk pools run by the Health and Human Services Department last summer to attract more people. Enrollment has grown since then, but still more slowly than anticipated.

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The ACA’s high-risk pools are also competing with ones that 35 states already had established before the law was even in place. Those 35 states’ legacy plans have almost 222,000 enrollees — still only a small segment of the roughly 50 million uninsured Americans. Some of the state pools are still growing, according to figures from the National Conference of State Legislatures. Others aren’t taking in new people because of the costs.

Goldman, who is also CEO of the Wisconsin state pool, said enrollment in that older pool has grown by 2,000 people over the past two years, while 940 have signed up for the newer program created by the national health care reform law.

“What it says is the difference is the [ACA pool] is targeting people chronically uninsured,” Goldman said. “Perhaps the state pool is insuring people that have been continually insured.”

The problem of chronic uninsurance could explain why Alaska’s high-risk pool has already spent $13 million — on just 45 people. When people that have traditionally gone without insurance finally get coverage, they tend to still look to hospitals first for care as they did when they were uninsured despite the cost, said Jean Hall, a University of Kansas research professor who’s studied high-risk pools.

As of last summer, government figures showed that seven out of 10 people who entered these new high-risk pools were in the state-administered ones, not the federal option. But Hall said that doesn’t mean that the government is doing a poor job.

Local conditions matter. Massachusetts and Vermont, for instance, have federally administered pools but virtually no one enrolled. That’s because Massachusetts already has its own health care reform law that expanded coverage. Vermont’s state laws also protect people with pre-existing conditions seeking coverage.

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